• Edward Koifman, Marco Magalhaes, Sarkis Kiramijyan, Ricardo O Escarcega, Romain Didier, Rebecca Torguson, Itsik Ben-Dor, Paul Corso, Christian Shults, Lowell Satler, Augusto Pichard, and Ron Waksman.
• Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
• Cardiovasc Revasc Med. 2016 Jul 1; 17 (5): 318-21.

ObjectiveTo compare early and late mortality of transfemoral (TF) and transapical (TA) transcatheter aortic valve replacement (TAVR) patients and assess predictors for mortality.BackgroundStudies have shown conflicting results regarding impact of access on outcome in severe aortic stenosis (AS) patients undergoing TAVR.MethodsAS patients undergoing TAVR between May 2007-December 2014 were included. Baseline demographic, clinical, and imaging parameters were compared according to access, and landmark analysis models were generated to assess outcomes and associated factors.ResultsAmong 648 severe AS patients undergoing TAVR, TF was used in 516 and TA in 132. Baseline characteristics between groups demonstrated lower body mass index, higher STS score, and rate of peripheral vascular disease among TA patients. Procedural complications were more common in the TA group, especially major bleeding (15% vs. 6%, p<0.001) and acute kidney injury >1 (8% vs. 1.4%, p<0.001). Landmark analysis demonstrated higher cumulative mortality rates at 30days among TA than TF patients (log-rank p<0.001), with similar mortality after 30days and up to 1-year (13% in both log-rank p=0.64). In a multivariate model, TA was an independent predictor of early mortality (HR=4.55 95% CI [12.5-1.6], p=0.003) along with pulmonary artery systolic pressure>60mmHg (HR=3.08 95% CI [7.37-1.29], p=0.01) and residual aortic regurgitation severity above mild (HR=3.99 95% CI [10.2-1.56], p=0.004).ConclusionsPatients undergoing TAVR via TA have higher adjusted early mortality and similar late mortality rates compared to TF, despite higher risk profile.Copyright © 2016 Elsevier Inc. All rights reserved.

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